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Treatment cubicle requirements are the same for children as adults; equip them with treatment tables and celling*mountad mirrors above.

Relate the area to outdoor therapy for outdoor exercises.

Provide a sink for the therapist's and children's use.

Toilet facilities for children should be immediately convenient to the exercise room and outdoor therapy-

Special equipment may have to be designed for individual cases. Figure 1» illustrates a movable stall bar and parallel bars adjustable in height and width for children of varying ages.

Occupational Therapy Equipment should be selected for the child's physical and mental age level. The plan indicates an area staffed by one therapist

Place toilet facilities convenient to the therapy room.

Relate the room to the outdoors so that some activities may be conducted outside.

Although specie! equipment may be required for individual cases, equipment indicated includes standing tables, typing tables, work tables (all with adjustable heights), loom, easel, and workbench.

Provide a sink within the room for the children's and therapist's use.

As training in eating may form a part of the

Fig. 20 Parking space for cars operated by dise bled nattons.

The Physical Plant

The physical plant shall provide a safa and sanitary environment with adequate diagnostic and therapeutic resources.

The design and construction of the physical plant should be appropriate to the type of services it houses, to the staffmg and organize« tionel pattern of the focility, and to local geography and style. It will, therefore, be unique for each facility, but it must be safe and must make a positive contribution to the efficient attainment of the facility's goals. It must satisfy the physiological es well as the psychological needs of patients and staff.

Sleeping units for patients are designed to promote comfort and dignity and to ensure privacy consistent with the patients welfare. In the absence of other state or local requirements, there is a minimum of BO sq ft of floor space in single rooms and 70 sq ft of floor space per person in multiple patient rooms. It is desirable that multiple patient rooms be designed to accommodate no more than six patients, but preferably four. There may be a need for appropriate security measures incorporated into the physical design of some wards.

There is e minimum of one lavatory for each six patients, one toilet for each eight patients, one tub or shower for each fifteen patients, and one drinking fountain on each ward. A lavatory is installed in each toilet area. Appropriate provisions are made to ensure privacy in toilet and bathing areas

Since psychiatric patients are generally ambulatory and need to associate with other patients and with staff, there is provision for day rooms and recreational areas At least 40 sq ft of floor space per patient is required for doyrooms, There are also usually solaria, a dining room or cafeteria where many patients take their meals, a viators' room, a gymnasium, an exercise area in the building or perhaps on the grounds, and rooms for special treatment, interviewing o! patients, group and individual therapy, etc. Other facilities for petients might include a locker room or individual lockers in the sleeping units, a small laundry room, a snack kitchen on each word, and a coffee shop, clothing shop, and cosmetic shop for patients as well as employees,

Offices are provided for physicians, psychologists, social workers, nursing administrators, dietitian, and other staff members, and these are conveniently located to encourage effective communication with patients and other staff, Nurses' stations should be centrally located to permit full view of recreation areas and immediate access to patients and to treatment areas Appropriate conference rooms are also provided, and there are suitable arrangements for clerical staff for each department or unit.

Standards tor Psychiatric Facilities, The American Psychistnc Association. Washington D C I9o9

SIX TYPES OF PSYCHIATRIC FACILITIES Community Mental Health Centers

The community mental health center represents the format reflection of the professional objectives of providing comprehensive services and continuity of care tor the prevention, early detection, treatment, and follow-up care of mental disorder within a designated population. The comprehensive center is essentially a program rather than a building complex; it is a program that seeks to plan and coordinate the range of mental health services required to meet the mental health needs of a population. It is a combination of services either under a single administration in a discrete physical entity, under a single administration in multiple physical facilities, or under various administrations which, by contracts and/or agreements, are organized to provide the continuity o! services noted above.

A center may be under governmental, philanthropic, or private auspices, or it may be supported by a combination of resources. If it is to be an effective agency, however, the Community served by the center should participate in establishing the major needs, goals, and priorities of the mental health center. The community and the staff of the mental health center muat define the goals and establish a priority system for the attainment of these goals. The community is ultimately responsible for identifying resources and needs, obtaining sufficient financial support to assure adequate numbers of competent personnel, adequately paid end given an adequate physical plant to implement the programs to achieve the stated goals.

As a minimum, the center must provide outpatient, inpatient, partial hospitalization (including day care) services, community consultation and professional education for other than the staff of the center, and clinical diagnosis and treatment on an emergency basis-It is also desirable that it participate in public education to promote or conserve mental health research to increase the body of knowledge about mental illness and the effectiveness of services utilized, home care and follow-up. nursing home care, vocational rehabilitation, guidance for the families of emotionally disturbed persons, and otherwise contribute to maintaining the optimal functioning of individuals with residual sequelae or complications of mental disorders. Services of the center should be easily accessible and widely publicized to the community served,

To provide comprehensive services and continuity of care, the community mental health center should have easy relationships with other "people-serving agencies, and partic* ularly with the public psychiatric hospital serving the area. Patient care must be coordi» nated between the center and other agencies, and patients must move from one element of service to another within the center with ease, as treatment needs indicate For example, In mental health centers that are part of or closely relaied to general hospitals, the necessary inpatient, dietetic, laboratory, pharmacy, medi cal, and surgical services might be provided by the general hospital. Arrangements need only be made to ensure availability and ready accessibility for patients in the mental health center.

To be truly comprehensive, the mental health center must be responsible for the adequacy of services provided to persons with special problem mental disorders or to populations facing unusually chronic end severe emotional stress and who are alienated from their community or the broader community's supportive social systems. It may not be feasible for the center to provide all of the clinical services necessary in managing the difficult biological and sociel problema presented by drug dependency, alcoholism, aging, delinquency, mental retardation,,or the many other special problems included among the mental disorders or in which mental disorder is suspected of playing s significant port. The center should, however, identify the population at risk for each of tha special problems and plan a program to provide preventive, diagnostic, therapeutic, rehabilitative, or supportive services for each of thesa populations, It should identify the community's most likely agents for early intervention to assist or support individuals in each of these populations or identify agents who are providing therapeutic and rehabilitative care. The program should indicate the ways in which the center would be most usefut to these community agents

The responsibility for the mental health needs of a population implies that the mental health center should help various social systems of the community function in ways that develop and sustain effectiveness of individuals participating in these systems. The center should aid these systems in their support of persons with mental disorder, The implications for prevention, diagnosis, treatment, and rehabilitation are obvious; the recipient of mental health services inoludes the patient but the services extend to his family and to a variety of social systems- Consultation and education in the community are important functions of any center. In these ways the centor responds to the community's need for interlocking, strengthening, and expansion of all its resources that have a bearing on mental health. Community consultation and education offer possibilities for influencing mental health beyond the confines of hospitals and offices and thus contribute to the prevention of mental disorder,

To deliver this brood range of services, a flexible organization with a multidisciplinary staff is required. In addition to the usual professional staff of psychiatrists, psychologists, social workers, nurses, and activity therapists, there may be a variety of nonprofessional personnel, volunteers, and sociol scientists to odd new perspectives to the center. Staff may be organized by services (prevention, diagnosis, intensive treatment, extended treatment, rehabilitation, etc.), by programs for specific population groups (children, adolescents, the aged, alcoholics, mentally retarded, etc.), or by geographic areas of ihe community served Regardless of the organization, there must be adequate qualified leadership, administrative and clinical, to assure thoughtful supervision, planning, evaluation, and coordination required to blend the array of available talents and resources into an effective center of services.

Responsibility and commensurale authority should be delegated to ensure optimal utilization of each person'« skills, respecting principles of ultimate legal and clinical responsibility. As stated elsewhere by the APA, "The need for cooperatively defining the area of activity and responsibility for professionals who participate in the care of patients requires that physicians or their designees be recognized as having the ultimate responsibility for patient care. They, and they alone, are trained to assume this responsibility. In the public ¡nteresi, other professionals or nonprofessionals, when contributing to patient care, must recognize and respect this ultimate responsibility.1

Psychiatric Outpatient Clinics

In a psychiatric outpatient clinic, a psychiatrist assumes responsibility for providing diagnostic, consulting, and therapeutic services tor outpatients with the help of a professional staff that includes at least the disciplines of psychiatry, psychology, and social work. This staff nucleus may be supplemented as needed by representatives of related disciplines, such as pediatrics, internal medicine, neurology, mental health nursing, speech therapy, remedial techniques, physical and occupational therapy, and rehabilitation-

Members of the various disciplines not only work on the staff but also function on the team in daily practice, coordinating their skills to meet the needs of patients. The psychiatrist who serves as director sees thai this coordination is effective. He sssumes responsibility for all clinical functions and is on duty sufficient time, on a regularly scheduled basis, to adequately discharge his responsibility He assures adequate evaluation of all new patients, supervision of the staff, and sustained direction of the total program of services- The psychiatrist-in-charge retains overall authority, but may delegate administrative, as distinct from clinical, responsibility to a nonmedical executive or administrator

In addition to diagnosing and treating patients, the clinic provides training for professional psychiatric personnel and those of other disciplines as well as education for the public; it participates in various community endeavors related to the mentally ill and carries out research. The methods of implementation and the proportionate emphasis given to the various functions differ according to local circumstances, community needs, and clinic policy.

The clinic may serve patients for whom appropriate psychiatric assistance in a convenient outpatient clinic may prevent more prolonged illness, those recovering from a stage of illness that required hospitalization and who may need further outpatient cara as they resume a regular way of life, Ihoee who are referred for prehoapitalization evaluation, and those who can benefit from temporary therapeutic intervention to overcome s life crisis.

Pnnctptes Und&rlymg Interdisciplinary Relations Between the Professions of Psychiatry and Psychology — A Position Statement by the Council of the American Psychiatric Association, February 1 964

Admission policies for outpatient clinics vary Many clinics have an "open door," or walk-in," policy, indicating that they accept both self-referrals and referrals from community agents. Others accept only those cases that have been referred by another professional source- Some clinics specialize in the diagnosis and treatment of children, adults, or special populations, such as people with alcohol problems. Each clinic has a written plan indicating the scope of its admission policy and referral plan, and the plan is well known to all referring sources.

The services of a clinic may be offered on either a full- or part«time basis, according to local circumstances. Whatever its arrangement, the clinic should be accessible to the members of the community it serves. For example, a clinic serving an area where many working people are paid by the day or hour with little or no provision tor sick leave should be open some evenings or weekends so as not to discourage or penalize those who would have to take a loss in pay to begin or continue treatment.

The clinic s participation in community service plans is an important responsibility Some individuals may have a problem that can best be removed or alleviated by another agency, and the clinic cooperates with other community resources wherever possible- Some patients need help from several sources, and the professionals involved must clarify the needs and outline areas in which each can be most effective. Working relationships with surrounding inpatient facilities are maintained to achieve easy flow of patients in and out of inpatient services and to avoid administrative delays end failure of communication about patients The clinic may be affiliated with a medical school, hospital, welfare or public health department. or other appropriate professional organizations for the exchange of services, scientific advancement, and professional and administrative support. If not, it achieves these aims through the use of qualified consultants or by establishing a professional advisory board of appropriately qualified persons.

The psychiatric outpatient clinic is often asked to furnish an evaluative report regarding a patient- The content of a report is determined by the purposes of the agency for which it is prepared and it is in keeping with ethical practice.

Psychiatric Services in General Hospitals

All general hospitals should have a well known plan for receiving, management and disposition of psychiatric patients- U the general hospital has a psychiatric service or department, there must he a qualified psychiatrist in charge, with appropriate allied personnel, particularly nursing personnel who have had training in the management of psychiatric patients.

Every general hospital must think through its responsibilities for the person presenting himself with psychiatric symptoms, in order either to admit the patient or to assist in quickly referring him to the nearest treatment resource capable of providing prompt diagnosis and treatment tor the particular case. The feasibility of establishing a psychiatric service In a general hospital as a part of the network of the total community health program will depend upon many factors, including local needs, the availability of other facilities, the availability of staff, and the orientation of the medical professional in the hospital and community.

Whether a separate psychiatric service can or cannot be provided, it is frequently possible to use some general medical, minimal care, or other beds for psychiatric patients and to secure the services ot a consultant psychiatrist. AM good general hospitals have a plan for handling psychiatric emergencies, such as acute toxic reactions, suicide attempts, and acute behavioral disturbances Small hospitals may have two or more rooms for such patients, pending their transfer to a hospital where special psychiatric facilities are available. It is advisable that no patient with suicidal tendencies be released without psychiatric consultation if a psychiatrist is available

When the general hospital has a psychiatric service, the service provides for the care and treatment ot patients admitted for psychiatric disorders and also tor those patients who, in the course of hospitalization for another reason, experience a psychiatric illness. Most patients are admitted voluntarily, although occasionally the hospital seeks legal authority for detaining one who is very disturbed, Any limitations on admissions, such as those imposed by the physical construction of the unit or by the training and experience ot its staff, are clearly slated in the plan of the hospital.

Bocause of the small size of the psychiatric unit in most general hospitals, the unit usually focuses on intensive short-term therapy and diagnostic services Some general hospitals have, however, found it possible to develop suitable facilities and staffing to admit and treat psychiatric patients who are expected to remain over 30 days. Some hospitols also have provision for partial hospitalization, in addition to round-the-clock services, and lor outpatient services to former patients and others who do not need full-time hospitalization.

Experience has indicated that, expressed as a percentage of the bed capacity of the hospital, the number of psychiatric beds required will vary from 3 to 1 5 percent, the most usual figure being about 10 percent of the total beds. A capacity of 20 to 26 beds in one nursing unit seems to be most efficient. When a hospital is capable of supporting more than this number of beds, they are usually provided in two or more nursing units. Experience has shown that men and women may be treated in one unit if adequate facilities are available.

Since the psychiatric service operates as an integral part of the hospital, many of its functional services are provided by the hospital administration, These might include most of the general professional services: i.e . medical, surgical, and dental, dietetic, laboratory, x-ray, pharmacy, library, chaplaincy, and medical records; and administrative and maintenance services.

Private Psychiatric Hospitals

Private psychiatric hospitals are nongovernmental specialty hospitals. Like general hospitals, they may be operated on either a nonprofit or for*proflt basis They have the responsibility of providing treatment programs with definitive goals for the welfare of the patient, with the realization that the period of hospitalization may be only a segment of the total treatment plan.

The medical staff should make uee of the opportunity provided by a high ratio of medical staff to patients to regulate the therapeutic program and to observe the processes of illness and the response to therapy. The most advanced approaches to treatment, and individualization of program to meet each patient s needs, should l>e employed. The hospital should take advantage of around-the-clock observations by many trained observers, and multidisciplinary views in conference, in the evaluation of therapy and the integration ol theory and practice. There should bo a periodic evaluation of the effectiveness of the hospital therapeutic program. Although the primary function of the hospital is to maintain excellence in psychiatric treatment, the professions? and administrative staff should be encouraged to utilize the unique opportunities for education and research.

Most private psychiatric hospitals serve their geographic communities — local» state, and regional — although a number of them, because of their special or unique treatment programs for specific categories of patients, receive referrals from wherever in the world these patients come.

Private psychiatric hospitals, therefore, vary greatly. Each follows the program determined by its medical staff, its approach to treatment and its goels. Each private psychiatric hospital must have established written procedures by which it will either admit a patient or quickly refer him to the nearest, most appropriate, treatment facility. A qualified psychiatriat must be responsible for the treatment of the patient, and there must be other mental health professionals, including nursing personnel with training in psychiatric nursing.

The length of stay in a private psychiatric hospital should be commensurate with the goals of therapy and the patient's illness. In keeping with the current concepts that early and effective intervention may result in the return of the patient to his community after a very short period of hospitalization, the average length of stay is less then 60 days in three-fourths of the private psychiatric hospitals. To meet the ultimate needs of the patient, many hospitals maintain medium- or long-term intensive treatment programs as well- The primary goal of hospital treatment la not the shortest possible stay but the moat effective therapy Within the limits of therapeutic goals, the hospital should provide the type and amount of treatment that will result in the patient a resumption of heafthy functioning

Public Psychiatric Hospitals

A public psychiatric hospital is defined as an institution provided by the community — whether city, county, state, provincial, or federal government — for the diagnosis, treatment, and care of patients with psychiatric and neurological disorders, Most hospitals in this group are state or provincial hospitals. They provide both short-term and long-term treatment and admit patients both voluntarily and by legal commitment.

While It is recognized that variations in the usual type of state hospital organization are suitable in certein localities, the essential professional, diagnostic, treatment, and administrative and maintenance services described in the preceding section on general standards can be applied to all public hospitals by individual interpretation Each public hospital has an important function to perform in providing necessary psychiatric services to its community and in promoting psychiatric education and research. Recognizing the sdvantages of affiliation with medical schools and other medical centers in their areas, many public hospitals have established formal programs of participation in cooperative educational and research efforts

Whether the total treatment program of the hospital is separated into discrete units depends upon its size, its type of organization, and the medical administrative philosophy However, patients have individual and differing needs, and the treatment program, however administratively organized, seeks to serve these various needs.

The hospital should be large enough to meet the community's needs for psychiatric services, but not so large as to compromise its ability to meet the needs of each patient for individual treatment. Optimal size might be described as the most efficient and effective balance between the facility s ability to meet the unique needs of the community and its ability to meet the unique needs of each patient One method that lias been devised to achieve this balance is the unit system.

Larger hospitals may operate under this system, with several semiautonomous patient care units making up the complex- The treatment programs are organized into separate units of similar site, staffing, and types of patients- Regardless of how long he stays, each patient is admitted, treated, and diecherged within the same unit. His treatment is the responsibility of the same group of staff members from admission to discharge and aftercare. In some instances, the units represent specific geographical areas, this enables ihe professional staff to work closely and continuously with professional and lay community agencies from that region. Other facilities do not find this geographic admission plan practical and prefer to admit patients to each unit in rotation. Regardless of how admissions are handled, the goal of each unit is appropriate treatment for each patient at the most appropriate site.

The treatment program may include separate wards for certain types of patients with special treatment, educational, and rehabilitation needs, such as children, adolescents, alcoholics, patients with tuberculosis, and others who require intensive medical treatment in addition to psychiatric care,

Increasingly, public hospitals are following the mental heelth center concepts of comprehensiveness of service and continuity of care. They are, therefore, developing a range of services, including programs of varying degrees of partial hospitalization, outpatient services, rehabilitation, vocational guidance, and aftercare in addition to the intensive inpatient treatment programs. A proper balance of these other programs allows for the more efficient use of the inpatient services

The concept of the "open door" has been applied to the majority of wards in moat psychiatric hospitals. The open hospital encourages early treatment by emphasizing the votun* tary nature of hospitalization and the expressed confidence of the staff that the patient can accept responsibility for his own management. Freedom of movement enables patients to do many things for themselves that might have to be done by staff members under othar conditions, and thus allows more staff time available for the promotion of active treatment. It is necessary for some facilities to maintain a closed ward or wards, however, for those patients who may be likely to endanger the safety and welfare of themselves and/or others. Confidence in the facility can best be maintained if appropriate precautions are taken to protect the community from the exceptional patient who has in the past caused it concern,

The hospital encourages and participates in community planning for the development of appropriate alternative resources and facilities to deal with social problems that have in the past often been assigned to the public psychiatric hospital due to the lack of available alternatives. The most appropriate and efficient use of scarce psychiatric resources requires that all possibilities for securing the best treatment and care for each individual patient be explored by the patient's family, the family phyaicien, and community social agencies, and that a broad range of resources be available in the community to meet the multiplicity of needs

The hospital encourages community provision for diagnostic, treatment, rehebilitation, and educational and preventive mental hygiene services for former patients, and for those for whom hospitalization may be averted, to ensure a comprehensive network of mental health care services. Within this network some services may be provided by the hospital's mental health clinic, which functions on a regular, scheduled basis, either in a fixed location or on a traveling basis The clinic assists in the rehabilitation of former hospital patients, advises those about to enter the hospital, offers treatment lo those who do not need hospitalization, and diagnoses and/or treats children with behavioral or educational problems. The staff of the clinic includes as a minimunf a psychiatrist. a social worker, and a psychologist, and, if the hospital has adopted the unit system, the same team follows the patient from preadmission interview to discharge and follow-up care. The services of the clinic also include follow-up counseling, evaluation of adjustment after discharge, and medical supervision of drug dosage.

Services for the Mentally Retarded

The past ten years or more have brought about a dramatic change of basic concepts regarding the care and treatment of persons with the mental retardation syndrome Consequently, requirements of care and treatment have shifted to an extent that the newly developed or developing facilitiea can no longer be considered as one compatible group of "hospitals and schools for mental defectives' aa was the case in earlier years.

First of all. the care, treatment, education and training of mentally retarded persons in the low borderline and educable range have shifted significantly from residential facilities to day schools. Trained or qualified educators along with other specialists (medicine, eudi-ology, speech, and physical therapy) provide meaningful and adequate services within the public school system or in schools operated by affiliates of the National Association for Retarded Children.

Secondly, the care, treatment, and training for more severely retarded children (tramables) are being provided in many communities in a manner similar to that In which these services are rendered for the youngsters who are ed-ucable.

As a third observation, it must be acknowledged that, tor some years now, there has been an observable trend for those persons who suffer from the rather severe to severest degrees of retardation {decarebration ayndromel to outnumber either the educable or the trainable retardates in state institutions. Their demand upon the availability of total lifelong care has become a dominant factor.

Thus, it is no longer possible to establish meaningful standards based upon traditional concepts. A new approach ia indicated that takes into consideration factual chengea and continued transition.

The complexities of needed services can best bit dealt with by projecting various life-span requirement« as known to us. However, wa shall not attempt to make specific recommendations tor those services that are nonmedical in nature.

Tba Infant and Small Child Most mentally retarded children are retarded at birth (prenatal and paranatal retardation), although it may not be evident at the time. They require diagnostic, prognostic, and treatment services.

The pre-school-age medical clinic may operate as an independent agency, a part of a general hospital, or a part of the atate hospitaltraining school system. In any event, utilization of existing services and efforts at integration In regional areas will be made and standards must be established end maintained to meet existing needs,

It is desirable that the director of the clinic be a well-qualified pediatrician. He will have medical consultants on his staff (neurologist, child psychiatrist, ophthalmologist, dentist, physiatriat, nutritionists, public haalth nurses, and others as needed) Essential are full-time or part-time qualified social workers, clinical or developmental psychologists, audiologists, speech, occupational, and physical therapists and medical secretaries. The number of staff employed must correspond to the needs of the patients referred to the clinic.

The clinic must have adequate space to function. It must have available all diagnostic tools and procedures that are necessary to establish an inclusive and comprehensive diagnosis, such as roentgenology, clinical and anatomic pathology, biochemistry, genetics, and electroencephalography.

All personnel must meet licensing and/or certification requirements of their respective professions. The clinic, if it is eligible, must meet the slandards of the Joint Commission on Accreditation of Hospitals.

The Younger School-Age Child Mentally retarded children, once properly diagnosed, will re quire a broad range of varying services

Children who ere ambulatory and without significant adjustment problems are, generally, entered into nursery schools with subsequent promotion into subprimary and appropriate grades of the public school system. State licensing procedures establish necessary standards for personnel end facilities.

Children who are not ambulatory or who have major adjustment problems that cannot be dealt with in the public school system or the private home may require tn-residence facilities that provide special orthopedic or psychiatric services or services to the blind, deaf, or others. All children in this category wilt be given the required additional diagnostic, treatment, rehabilitative, and educational services that are needed to assist them to develop their optimal potential Such programs must be mul-tidiaciplinary, under qualified medical direction. Thus, they must meet the requirements of the Joint Commission on Accreditation of Hospitals.

As the process of treatment and rehabilitation progresses, a differentiation of each child's long-range needs will become evident. It may lead to discharge into the community and referral to a child guidance clinic and to the public special school system. It may require prolonged hospitalization because of specific medical requirements. Or, it may result in providing lifelong protective care in an accredited institution tor the chronically ill (amended care unit), a licensed nursing home, or a licensed boarding home. In any event, local, state, and/ or federal licensing requirements must be met and the facility should be accredited by the Joint Commission on Accreditation of Hospitals if it is etigible-

Tha Progressing Preadole&cents and Adolescents

Most of the mentally retarded youngsters in the educational and training programs will reach the limit of their academic potential before the age of sixteen. Therefore, it is necessary that meaningful and adequate prevoca-

tional programs be available et the appropriate lime, Whether such a program is part of a public school system or an integral part of a private or public residential care facility, it must meet the licensing and certification requirements of the state and/or federal government, Under the current legal definition, a mentally retarded youngster capable of rehabilitation, as interpreted by the Division of Vocational Rehabilitation, qualifies at age sixteen to participate in this program,

Adequate day care programs and/or domiciliary facilities must meel the program needs of the clients. Also, they must meet licensing or certification requirements of each licensing body (department of health, department of labor, department of education, the fire marshal, department of insurance, etc.).

The Young Adufl and the Adutl 8y the lime « retarded person is eighteen years of age, his future role in our society can be assessed fairly accurately, in most instances- The need may range from living more or less independently in the community or in a supervised group-living program (hostel, sheltered workshop) to residence in a licensed boarding home, a licensed nursing home, or in an institution for chronically disabled or ill persons Correspondingly, he may be economically independent, partially self-supporting, or receive public support through Medicare, Medicaid, Social Security, or aid to the permanently and totally disabled.

In any event, adequate legal and social provisions must be made to protect the person with the mental retardation syndrome against physical, emotional, social, or economic exploitation and abuse. Also, regardless of where the retarded adult lives, he must have adequate access to all community resources that he may need at any given lime in his life span. Thie will require programmed supervisory services that can be included in an adequate protective mechanism (Guardianship Act).

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